Executive Director, Appeals Process & Technology – Aetna

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

The Executive Director, Appeals Process & Technology leads a critical function responsible for driving the coordinated effort to migrate Aetna Grievances & Appeals business processes to a modernized technology platform. This role owns the strategy and execution of a large, complex, cross-functional program to create more efficient and consistent processes, reduce rework and manual activity, and maintain quality, compliance, and adherence to plan sponsor requirements.

The role requires a proven operator who can lead through complexity, influence at the executive level, and build high-performing teams within a highly matrixed environment.

Partner closely with Product leadership to align business strategy with product vision, roadmaps, and lifecycle decisions to optimize workflows, enhance reporting capabilities, and improve operational scalability. Define and communicate the long-term business strategy for technology products supporting A&G teams, including business outcomes, KPIs, and success measures. Provide executive guidance to ensure business requirements and outcomes are integrated into technology delivery plans.

Lead platform migration strategy, planning, and execution in partnership with DDAT and Operations leaders. Serve as a matrix leader across A&G, Technology, Compliance, Operations, Medical, Claims, and other key partners.

Lead development of business cases and establish investment priorities in partnership with A&G functional leaders, DDAT, and other stakeholders. Make enterprise-level trade-off decisions related to scope, sequencing, funding, and business value. Oversee program and technology spend, ensure budget discipline, and track expected business benefits and operational efficiencies.

Lead teams in developing and updating policies, workflows, and job aids in partnership with accountable Operations teams. Ensure new platform functionality and business processes are reflected in consistent workflows while balancing the need to minimize system customization with plan sponsor requirements. Champion continuous process improvement and partner with Learning & Performance and Operations teams to coordinate training.

Lead process assurance and quality routines across A&G Operations teams, ensuring they are independent, fair, consistent, and well understood. Ensure quality processes align with plan sponsor expectations, regulatory requirements, and audit readiness. Use process assurance findings to strengthen policies, workflows, training, and operational processes.

• 15+ years of leadership experience within a healthcare payer or similarly complex, regulated healthcare environment.
• Proven experience leading leaders and large-scale, front-line operational teams.
• Demonstrated experience leading significant technology or platform initiatives while maintaining accountability for operational outcomes.
• Strong health plan operations experience; experience within Grievances & Appeals, Utilization Management, Claims, Medicare, or related payer functions is highly valued.
• Strong operational acumen, including…